Plasmin-alpha(2)-antiplasmin complex in patients with atrial fibrillation

Plasmin-alpha(2)-antiplasmin complex (PAP) is an index of recent fibrinolyt ic activity. We examined PAP levels in patients with atrial fibrillation (A F) to determine whether these levels are correlated with clinical character istics associated with stroke risk. We obtained blood for measurement of PA P in a non-random sample of 586 patients with AF on entering the Stroke Pre vention in Atrial Fibrillation ill Study. PAP levers were measured with an ELISA assay. PAP Values were transformed with a natural logarithm (PAP(ln)) prior to all analyses. Older age, female gender, recent congestive heart f ailure, decreasing fractional shortening, recent onset of AF, and coronary artery disease were each univariately associated with higher levels of PAP (all p < 0.05, two-sample t-test, simple linear regression). Older age, rec ent congestive heart failure, decreasing fractional shortening, and recent onset of AF were independently associated with higher PAP levels by multiva riate analysis (linear regression). Among patients receiving warfarin, PAP levels were not correlated with INR levels (linear regression, p = 0.60). P atients classified as high-risk for thromboembolism by our risk stratificat ion criteria (systolic blood pressure > 160 mm Hg, prior thromboembolism, r ecent congestive heart failure, poor left ventricular function, and women o ver age 75) had higher PAP levels than low-risk patients (antilog mean PAP( ln) 5.6 vs 4.9, p < 0.001, two-sample t-test). PAP levels in patients with AF are associated with clinical characteristics predictive of thromboemboli sm. Elevated PAP levels are particularly associated with poor left ventricu lar function and are not affected by anticoagulation. PAP levels may be a m arker of stroke risk in patients with AF.